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Fallon Health Clinical Integration Navigator - Central Part of the State-Fluent in Spanish highly desired in Worcester, Massachusetts

Overview

Passionate about Helping People? Enjoy working with the Elderly? Looking for No Weekends/ No Holidays & Work/Life Balance?

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

About NaviCare :

Fallon Health is a leader in providing senior care solutions such as NaviCare, a Medicare Advantage Special Needs Plan and Senior Care Options program. Navicare integrates care for adults age 65 and older who are dually eligible for both Medicare and MassHealth Standard. Apersonalized primary care team manages and coordinates the NaviCare member’s health care by working with each member, the member’s family and health care providers to ensure the best possible outcomes. The Navigator is an integral part on an interdisciplinary team focused on care coordination, care management and improving access to and quality of care for Fallon members.

Brief summary of purpose:

The Navigator partners with Fallon Health Care Team staff and other providers to communicate at all times what is occurring with the member and their status. The Navigator seeks to establish telephonic and face to face (depending upon product and circumstance) relationships with the member/caregiver(s) and provider partners to better ensure ongoing service provision and care coordination, consistent with the member specific care plan.In order to effectively advocate for member needs, the Navigator may make in home or facility visits (depending upon the product and circumstances) with or without other Care Team members to fully understand a member’s care needs.

Responsibilities

Responsibilities include but are not limited to:

  • Utilizes an ACD line to support department and incoming/outgoing calls with the goal of first call resolution with each interaction

  • Conducting telephonic and may conduct face to face member visits to assess members utilizing TruCare Assessment Tools

  • Establishing and developing effective working relationships with community partners such as housing staff, adult day health care staff, assisted living staff, group adult foster and adult foster care staff, rest home staff, long term care facilities and other providers including primary care providers with the goal to facilitate member specific communication, represent Fallon Health in a positive and effective manner, and work to grow membership in the various Fallon Health products as applicable

Qualifications

Education: College degree (BA/BS in Health Services or Social Work) preferred

License/Certifications: Current MA Driver’s License and reliable transportation. No certifications are required. 

Other: Satisfactory Criminal Offender Record Information (CORI) results.

Experience:

  • 2+ years job experience in a managed care company, medical related field, or community social service agency required

  • Understanding of hospitalization experiences and the impacts and needs after facility discharge required

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

PM16

Location US-MA-Worcester

Posted Date 1 month ago (3/1/2021 4:12 PM)

Job ID 6244

# Positions 1

Category Administrative/Clerical

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